A geriatrician is a medical doctor who specializes in the unique health care needs of older adults, typically focusing on patients over the age of 65 with complex conditions. They complete a residency in internal or family medicine followed by a specialized fellowship in geriatric medicine, providing them with expanded expertise in the aging process. The role of a geriatrician is to manage the complexities that arise from multiple interacting health problems common in later life, recognizing that older patients require distinct treatment approaches compared to younger adults.
Specialized Areas of Geriatric Care
Geriatricians focus on age-related health issues known as geriatric syndromes, which often do not fit neatly into a single disease category. These include frailty, a state of increased vulnerability resulting from a cumulative decline in multiple body systems. They also manage polypharmacy, addressing the challenges of multiple medications (often five or more) to avoid adverse drug interactions and side effects.
Cognitive impairment, ranging from mild memory issues to advanced dementia, is a core area of expertise. Geriatricians diagnose and manage neurodegenerative conditions, distinguishing them from delirium, an acute change in attention often triggered by illness or medication. Mobility is also a major focus, as they address instability and balance issues to prevent falls, a leading cause of injury and functional decline.
The management of incontinence, both urinary and fecal, is a routine part of their practice. Geriatricians also address chronic conditions like osteoporosis, arthritis, and heart disease. They view these illnesses through the lens of how they impact the older person’s daily function and quality of life, tailoring treatment plans to account for physiological changes and increased susceptibility to complications.
The Geriatric Approach to Health
The fundamental difference in the geriatrician’s philosophy is their holistic, patient-centered approach, which differs from the traditional focus on single-disease treatment. This method centers around the Comprehensive Geriatric Assessment (CGA), a structured, multidimensional evaluation that goes beyond a standard medical history and physical exam. The CGA systematically evaluates a person’s medical conditions, mental health, functional capacity, and socioenvironmental situation.
A primary goal of the CGA is determining the patient’s functional status, which includes their ability to perform activities of daily living (ADLs) like dressing and bathing, and instrumental activities of daily living (IADLs). The geriatric approach prioritizes quality of life and maintaining independence, ensuring that interventions align with the patient’s personal goals and preferences. This assessment also includes psychological factors, such as mood and cognition, and social circumstances, including living arrangements and caregiver support.
The CGA is the foundation for an integrated, coordinated treatment plan that addresses all identified problems simultaneously. By considering the interplay between physical, cognitive, and social factors, the geriatrician optimizes medical treatments and rehabilitation plans. This comprehensive evaluation also helps to avoid the complications of hospitalization and informs long-term care requirements and discharge planning.
When Consultation is Recommended
Consultation with a geriatrician is indicated by the complexity of a person’s health profile, not by age alone. A clear trigger is the management of multiple chronic diseases, especially when treatments for one condition complicate another. Patients taking five or more prescription drugs can benefit from a specialist review to address polypharmacy and potential drug interactions.
Rapid functional decline, such as new difficulty with walking or managing household tasks, is a strong indicator. Other triggers include frequent hospitalizations or emergency room visits suggesting unmanaged health issues. Consultations are also valuable for unmanaged cognitive changes, such as persistent memory loss, or when caregiver stress becomes overwhelming.
The Multidisciplinary Care Team
Geriatric care uses a team-based approach, with the geriatrician coordinating a wide array of non-physician professionals. This multidisciplinary team ensures that all aspects of the patient’s holistic care plan are addressed through specialized expertise.
The team includes several key professionals:
- Specialized nurses and nurse practitioners manage ongoing care and conduct comprehensive patient assessments.
- Pharmacists conduct structured medication reviews to optimize drug regimens and manage polypharmacy.
- Physical therapists (PT) address mobility, gait, and balance to prevent falls.
- Occupational therapists (OT) help patients adapt to maintain independence in daily activities.
- Social workers provide essential support by addressing social and financial needs and connecting patients with community resources.